全层输尿管撕脱伤处理并文献复习（附4例报告）

Management of Complete Ureteral Avulsion and Literature Review （ a report of 4 cases）

【目的】探讨输尿管全层撕脱伤的诊治措施。【方法】2003年11月至2008年3月本院收治输尿管撕脱伤患者4例，其中1例输尿管肾盂撕脱行输尿管肾盂吻合术＋大网膜外面包裹；1例近端输尿管撕脱伤者行自体肾移植术；另2例远端输尿管撕脱伤患者行输尿管-膀胱吻合术。随访16～45个月，平均29个月。【结果】1例行自体肾移植术、输尿管膀胱吻合术后患者及2例行输尿管膀胱吻合术患者肾功能恢复良好；1例行输尿管-肾盂吻合术患者出现肾积水、肾脏无功能，行肾切除术。【结论】输尿管全层撕脱伤是罕见但严重的并发症，自体肾移植及输尿管膀胱吻合术可能是输尿管近段撕脱伤的理想治疗方法。

[Objective] To investigate the treatment of complete ureteric avulsion. [Methods]The data of 4 patients with complete ureteric avulsion between November 2003 and March 2008 in our hospital were analyzed retrospectively. One case with ureteropelvic avulsion underwent pyeloureterostomy and greater omentum investment outside to the native distal. One case with proximal ureteral avulsion underwent autotransplantation of kidney. Another 2 cases with distal ureteral avulsion underwent ureterovesical anastomosis. All 4 patients were followed up for 16-29 months with the average of 29 months. [Results] Three patients treated by autotransplantation of kidney or ureterovesical anastomosis had good recovery of kidney function. The patient treated by pyeloureterostomy developed hydronephrosis and non-functioning kidney, and turned to perform nephrectomy. [Conclusion] Complete ureteral avulsion is a rare but severe complication. Autotransplantation of kidney or ureterovesical anastomosis may be the ideal methods for treating proximal ureteral avulsion.